In the twelfth of our 16 blogs for 16 days, Lucy Downes, Project Lead for Social Franchising at IRISi talks about the real life impact the IRIS programme has on women all across the UK.
IRIS is a specialist domestic violence and abuse (DVA) training, support and referral programme for General Practices that has been positively evaluated in a randomised controlled trial.
IRIS is a collaboration between primary care and third sector organisations specialising in DVA. Core areas of the programme include ongoing training, education and consultancy for the clinical team and administrative staff, care pathways for primary health care practitioners and an enhanced referral pathway to specialist domestic violence services for patients with experience of DVA.
IRISi is a not-for-profit social enterprise established to improve the healthcare response to gender-based violence. IRIS is our flagship intervention and so we support areas to commission, implement and maintain the IRIS programme. I have written and spoken the words above about the IRIS programme tens, or even hundreds, of times since joining the team at IRISi as a Regional Manager over two years ago. These words go into our presentations, our training resources, and our promotional materials. I know them off by heart.
I can talk at length now about the robust evidence base for the effectiveness of IRIS and about its cost effectiveness. I can write about how it is considered the gold standard for an intervention to improve the general practice response to domestic abuse, cited as it is in numerous regional and national strategies and policies. I can explain how IRIS enables clinicians and general practices to meet the NICE guidelines and standards (2014 and 2016) on domestic abuse. I write about and speak about IRIS to and with lots of different types of audiences – commissioners in CCGs, in Public Health, and in other local commissioning bodies, chief execs and service managers in domestic abuse services, and academics, researchers and evaluators working in the sector.
My work, and our work at IRISi, is often focussed on discussions and decisions happening between commissioners and domestic abuse service managers: what is the patient population in the area in which commissioners wish to see IRIS implemented? How large a local IRIS team will be needed? How much will it cost to implement IRIS? What impact can be achieved for a budget of £X? What are the expected outputs and outcomes of the IRIS programme? How are the outcomes going to be evidenced and reported on?
Whilst the words at the top trip easily off my tongue now it’s easy to forget what they actually mean. Discussions and decisions about budgets, staff recruitment, outcomes and evidence are necessary, because they enable the IRIS programme to happen in a particular area, but it’s easy to become wrapped up in these discussions and distant from the difference that the IRIS programme makes to people at the level of individuals.
Then, every once in a while, something I read or hear something that a patient has said that stops me in my tracks and brings into sharp focus why we all do our jobs:
‘Thank you for listening’
‘Thank you for helping’
‘So SO good to talk to [the AE], to feel believed, to feel understood, to realise what happened to me was not my fault & to see things differently. Thank you.’
‘Thank you, that first meeting was hard, but the help & support I have received has changed my life.’
‘Whatever you have going on with GPs in [IRIS area] is so important – that link is incredible – I am forever indebted to my GP for piecing it all together and for getting me that help.’
This is what IRIS does. These are the outcomes. This is the impact. Forget for a minute about the numbers, about working out what percentage of the patient population have been referred and whether targets or KPIs have been met. Listen to what patients say about the IRIS programme.
For victims and survivors, being listened to, heard and understood is the necessary first step towards safety, choice, empowerment and freedom.
The chance to speak to an experienced domestic abuse specialist in a safe and familiar environment can be life changing for victims and survivors of domestic abuse.
Of course, domestic abuse services other than IRIS provide support to victims and survivors to increase their safety, enable them to make informed choices, and to make dramatic changes in their lives and those of their children. But the final patient who I have quoted says something that is fundamental to the IRIS programme: the link between the IRIS advocate educator and the general practices she trains and works with is ‘incredible’. This link is what we mean when we write that ‘IRIS is a collaboration between primary care and third sector organisations specialising in DVA’. And ‘piecing it all together’ is what IRIS enables clinicians to do through the provision of the ‘training, support and referral programme for general practices’ that we talk and write of so often.Without IRIS training, GPs and other general practice clinicians often have not had the training to equip them with the knowledge and skills to piece together the symptoms and conditions experienced by their patients with the possibility that these symptoms are linked to domestic abuse.
IRIS isn’t just about training though. Training helps clinicians to identify and ask about DVA, but training alone rarely brings about long term positive change to the general practice response to domestic abuse. The final patient quoted says ‘I am forever indebted to my GP for piecing it all together and for getting me that help’. Getting patients that help is crucial. IRIS is as much about the referral pathway for patients, and the ongoing support provided by the AE to the practice team, as it is about the training. It is this referral pathway and support that enables clinicians to feel confident to ask about domestic abuse; the availability of a named, known and trusted advocate educator, who can visit patients in the safety and familiarity of their own practice, means that clinicians know exactly what to do, and what to expect, if a patient answers ‘yes, this is affecting me’. Through this combination of training, a referral pathway, and ongoing support, the IRIS programme enables a sustained change in the way in which clinicians address and respond to domestic abuse. Ultimately this change in clinical practice changes patients’ lives profoundly. So next time we’re wrapped up in the language and concerns of commissioning, budgets and management, let’s remember what patients tell us about the IRIS programme.
Lucy Downes is Project Lead for Social Franchising at IRISi. For more information on how IRIS can help you and your practice, please get in contact with us here.